To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone. Methods： Twenty-seven patients...To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone. Methods： Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage （ENBD） were divided equally into three groups, and administered respectively with Lidanling （利胆灵, the LDL group）, ursodesoxycholic acid （the UDA group） and combination of LDL and UDA （the LDL＋ UDA group） through oral intake（7 patients in each group）. Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7th day after the treatment started to detect levels of total bile acid （TBA）, glycocholic acid （GCA）, taurocholic acid （TCA）, glycocholic cheno-desoxycholic acid （GCDCA）, total bilirubin （TBIL）, uncombined bilirubin （ UCB）, concentration of calcium ion （Ca^2＋ ） as well as the bacterio-genetic and endogenous 13-glucuronidase activity for comparing. Results： Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL ＋ UDA group after treatment （ P〈0. 05）, while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL ＋ UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment （P〈0. 05）. Moreover, levels of Ca^2＋ and endogenous β-glucuronidase activity got significantly lowered （ P〈0. 05）. Conclusion： Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca^2＋ and the activity of endogenous β-glucuronidase in the bile, so as to reduce the possibility of stone formation展开更多
AIM： To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn＇s disease. METHODS： Gallbladder bile was obtained from patients with Crohn＇s disease who were admitted for...AIM： To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn＇s disease. METHODS： Gallbladder bile was obtained from patients with Crohn＇s disease who were admitted for elective surgery （27 with ileal/ileocolonic disease and 7 with Crohn＇s colitis）. Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids, bile acids, bilirubin, crystals, and crystal detection time （CDT）. Cholesterol saturation index was calculated. RESULTS： The biliary concentration of bilirubin was about 50% higher in patients with Crohn＇s disease than in patients with cholesterol gallstones. Ten of the patients with Crohn＇s disease involving ileum and three of those with Crohn＇s colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn＇s disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn＇s disease, with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn＇s colitis probably not due to bile acid malabsorption. CONCLUSION： Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn＇s disease.The skillful technical assistance of Ms Lisbet Benthin and Ms Ingela Arvidsson is acknowledged.展开更多
文摘To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone. Methods： Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage （ENBD） were divided equally into three groups, and administered respectively with Lidanling （利胆灵, the LDL group）, ursodesoxycholic acid （the UDA group） and combination of LDL and UDA （the LDL＋ UDA group） through oral intake（7 patients in each group）. Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7th day after the treatment started to detect levels of total bile acid （TBA）, glycocholic acid （GCA）, taurocholic acid （TCA）, glycocholic cheno-desoxycholic acid （GCDCA）, total bilirubin （TBIL）, uncombined bilirubin （ UCB）, concentration of calcium ion （Ca^2＋ ） as well as the bacterio-genetic and endogenous 13-glucuronidase activity for comparing. Results： Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL ＋ UDA group after treatment （ P〈0. 05）, while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL ＋ UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment （P〈0. 05）. Moreover, levels of Ca^2＋ and endogenous β-glucuronidase activity got significantly lowered （ P〈0. 05）. Conclusion： Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca^2＋ and the activity of endogenous β-glucuronidase in the bile, so as to reduce the possibility of stone formation
基金Supported by grants from the Swedish Research Council and Karolinska Instituter
文摘AIM： To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn＇s disease. METHODS： Gallbladder bile was obtained from patients with Crohn＇s disease who were admitted for elective surgery （27 with ileal/ileocolonic disease and 7 with Crohn＇s colitis）. Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids, bile acids, bilirubin, crystals, and crystal detection time （CDT）. Cholesterol saturation index was calculated. RESULTS： The biliary concentration of bilirubin was about 50% higher in patients with Crohn＇s disease than in patients with cholesterol gallstones. Ten of the patients with Crohn＇s disease involving ileum and three of those with Crohn＇s colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn＇s disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn＇s disease, with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn＇s colitis probably not due to bile acid malabsorption. CONCLUSION： Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn＇s disease.The skillful technical assistance of Ms Lisbet Benthin and Ms Ingela Arvidsson is acknowledged.
